When the primitive sciatic artery remains the major artery in the thigh, the superficial femoral artery is usually poorly developed or absent. This abnormal vasculature is ascribed to the persistent embryologic arterial system which can occur unilaterally or bilaterally. Sciatic artery is known to be susceptible to aneurysmal changes. Pulsatile gluteal mass, distal embolization and, lower extremity ischemia in the sitting position are the pathognomonic clinical symptoms. Excision of the sciatic artery combined with femoro-popliteal bypass is the established recommended surgical treatment.